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Gerger H, Søgaard K, Macri EM, Jackson JA, Elbers RG, van Rijn RM, Koes B, Chiarotto A, Burdorf A. Exposure to hand-arm vibrations in the workplace and the occurrence of hand-arm vibration syndrome, Dupuytren's contracture, and hypothenar hammer syndrome: a systematic review and meta-analysis. J Occup Environ Hyg 2023; 20:257-267. [PMID: 37000463 DOI: 10.1080/15459624.2023.2197634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
This study provides an overview of the relationships between exposure to work-related hand-arm vibration and the occurrence of pre-defined disorders of the hands. We searched Medline, Embase, Web of Science, Cochrane Central, and PsycINFO for cross-sectional and longitudinal studies on the association between work-related vibration exposure and the occurrence of hand-arm vibration syndrome (including vibration-induced white finger), Dupuytren's contracture, or hypothenar hammer syndrome. We used a 16-item checklist for assessing the risk of bias. We present results narratively, and we conducted random effects meta-analyses if possible. We included 10 studies with more than 24,381 participants. Our results showed statistically significant associations between the exposure to hand-arm vibrations and the occurrence of the selected disorders, with pooled odds ratios ranging between 1.35 (95% CI: 1.28 to 2.80) and 3.43 (95% CI: 2.10 to 5.59). Considerable between-study heterogeneity was observed. Our analyses show that exposure to vibrating tools at work is associated with an increased risk for the occurrence of selected disorders of the hands. Due to the majority of studies being cross-sectional, no firm conclusion is possible regarding causal relationships between vibration exposure and disorder occurrence. Future research should specifically address whether reducing exposure to hand-held vibrating tools at work reduces the incidence of the disorders of the hands investigated in this systematic review.
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Affiliation(s)
- Heike Gerger
- Department of General Practice, Erasmus Medical Center, University Medical Center, Rotterdam, Netherlands
| | - Karen Søgaard
- Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Erin M Macri
- Department of General Practice, Erasmus Medical Center, University Medical Center, Rotterdam, Netherlands
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center Rotterdam, Rotterdam Netherlands
| | - Jennie A Jackson
- Centre for Musculoskeletal Research, Department of Occupational Health Sciences and Psychology, University of Gävle, Gävle, Sweden
| | - Roy G Elbers
- Department of General Practice, Erasmus Medical Center, University Medical Center, Rotterdam, Netherlands
| | - Rogier M van Rijn
- Codarts Rotterdam, University of the Arts, Rotterdam, the Netherlands
- Performing artist and Athlete Research Lab (PEARL), Rotterdam, the Netherlands
| | - Bart Koes
- Department of General Practice, Erasmus Medical Center, University Medical Center, Rotterdam, Netherlands
- Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
| | - Alessandro Chiarotto
- Department of General Practice, Erasmus Medical Center, University Medical Center, Rotterdam, Netherlands
| | - Alex Burdorf
- Department of Public Health, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands
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Estíbaliz A, Eztizen L, Osman-alberto S, Bryan-josué F, Valvanera P, Lerena LT, Juan-antonio L. Bilateral Hypothenar Hammer Syndrome Case Presentation and Literature Review. Case Rep Vasc Med 2022; 2022:1-4. [PMID: 35800397 PMCID: PMC9256417 DOI: 10.1155/2022/2078772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 05/27/2022] [Accepted: 06/20/2022] [Indexed: 11/26/2022] Open
Abstract
Hypothenar hammer syndrome is a rare cause of vascular insufficiency. Generally, patients report a history of repetitive trauma to the hypothenar region of the hand. Symptoms often consist of cold intolerance, pain, paleness, and paresthesia due to digital ischemia. The severity of these symptoms will depend on the extent of ulnar artery occlusion and the presence or absence of collaterals between this artery's superficial and deep branches. It is a rare clinical entity, which on multiple occasions requires a surgical approach. We present a 63-year-old man with bilateral Raynaud's phenomenon secondary to hypothenar hammer syndrome successfully treated by vascular repair surgery. In patients with Raynaud's phenomenon, it is important to know that there are reversible causes such as hypothenar hammer syndrome.
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Wahl U, Ochsmann E, Siemers F, Corterier CC, Hirsch T. [Accident-related and workplace-related vascular disorders of the hand]. Unfallchirurg 2022. [PMID: 34989852 DOI: 10.1007/s00113-021-01127-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Limited hand function as the result of occupational exposure or accidental injury could primarily be of vascular origin. Since it is quite rarely seen in the course of routine traumatology, special awareness of this is needed. AIM OF THE PAPER The occupational diseases hypothenar/thenar hammer syndrome (occupational disease 2114) and vibration-induced vasospastic syndrome (occupational disease 2104) are presented on the basis of their etiological and pathogenetic characteristics, taking aspects of occupational medicine and expert opinion into consideration. DISCUSSION Blunt force trauma to vascular structures of the hand can damage the tunica intima of the affected thenar or hypothenar arteries. Chronic exposure of the arms, hands and fingers to vibration can lead to the injury of nerve and vascular structures. Thermometry and pallesthesiometry are used in the diagnostics alongside methods of vascular medicine. CONCLUSION Vascular entities can also play a role in the surgical assessment of the impact of an accident or of an occupational disease after exposure to vibration. Awareness of them can shorten the latency between the onset of symptoms and a definitive diagnosis.
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Jud P, Pregartner G, Berghold A, Rief P, Muster V, Gütl K, Brodmann M, Hafner F. Endovascular Thrombolysis in Hypothenar Hammer Syndrome: A Systematic Review. Front Cardiovasc Med 2021; 8:745776. [PMID: 34977173 PMCID: PMC8714786 DOI: 10.3389/fcvm.2021.745776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 11/23/2021] [Indexed: 12/24/2022] Open
Abstract
Objectives: Hypothenar hammer syndrome (HHS) is a rare vascular disease caused by blunt trauma of the hypothenar region. The optimal therapeutic strategy remains debatably since no large comparative studies are available yet. We want to evaluate the effectiveness of intra-arterial thrombolysis on angiographic and clinical outcome parameters in patients with HHS by performing a systematic review of the existing literature. Methods: A literature search of PUBMED/MEDLINE and SCIENCE DIRECT databases was performed up to May 2021. Results: In total, 16 manuscripts with 43 patients were included in the systematic review. Intra-arterial thrombolysis led to angiographic improvement in 29 patients (67.4%) and to clinical improvement in 34 patients (79.1%). Deterioration of arterial perfusion or clinical symptoms after thrombolysis were absent. Post-interventional complications were reported in only one patient (2.3%) without any bleeding complication. Logistic regression analyses demonstrated that a combined administration of fibrinolytics and heparin was associated with a significantly improved arterial patency [OR 12.57 (95% CI 2.48–97.8), p = 0.005] without significant amelioration of clinical symptoms [OR 3.20 (95% CI 0.6–18.9), p = 0.172]. The use of rt-PA compared to other fibrinolytics and a prolonged thrombolysis duration of more than 24 h did not show statistically significant effects. Intra-arterial thrombolysis was significantly less effective in patients who had undergone thrombolysis with a delay of more than 30 days regarding clinical improvement [OR 0.07 (95% CI 0.00–0.54), p = 0.024]. Conclusions: Intra-arterial thrombolysis with a combination of fibrinolytics and heparin is an effective and safe therapeutic option in patients with acute HHS.
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Affiliation(s)
- Philipp Jud
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- *Correspondence: Philipp Jud
| | - Gudrun Pregartner
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Andrea Berghold
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Peter Rief
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Viktoria Muster
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Katharina Gütl
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Marianne Brodmann
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Franz Hafner
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Ohlander J, Keskin MC, Weiler SW, Stork J, Radon K. Snap-fit assembly and upper limb functional limitations in automotive production workers: a nested case-control study. Int Arch Occup Environ Health 2019; 92:813-9. [PMID: 30815732 DOI: 10.1007/s00420-019-01418-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 02/19/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The use of snap-fits in car-part assembling has developed into an industrial standard. Cross-sectional evidence indicates, however, that this assembling process might adversely affect workers' upper limb function. The objective of this study was to analyze incident cases of upper limb functional limitations (ULFL) in relation to exposure to snap-fit assembly. METHODS We performed a nested case-control study within a population of 5139 blue-collar automotive production workers. Cases with ULFL detected during follow-up were matched with controls based on employment duration and investigated on their exposure to snap-fit assembly. By conditional logistic regression, we modeled the risk for ULFL according to person-years of exposure to snap-fit assembly, adjusted for gender and baseline BMI. RESULTS Overall, 64 ULFL cases were detected during a follow-up of 20610.8 person-years (3.1 cases per 1000 person-years). Cases, matched with an average of 4 controls, had significantly longer exposure duration to snap-fit assembly compared with controls (M = 1.15 person-years, SD = 1.68 person-years vs. M = 0.41 person-years, SD = 1.25 person-years). One person-year of exposure to snap-fit assembly was associated with an approximate 20% risk increase of developing ULFLs (OR 1.23, 95% CI 1.08-1.39). CONCLUSIONS We confirm an association between accumulated exposure to snap-fits in car-part assembling and upper limb musculoskeletal disorders. Company physicians should thus be vigilant to symptoms of musculoskeletal disorders of the upper limbs in snap-fit assembly and support the development of threshold values for snap-fit insertion forces.
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Fung AT, Culig J, Taylor DC. Firearm-related hypothenar hammer syndrome in a police officer. J Vasc Surg Cases Innov Tech 2018; 4:223-225. [PMID: 30175295 PMCID: PMC6116776 DOI: 10.1016/j.jvscit.2018.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 05/16/2018] [Indexed: 11/24/2022]
Abstract
Hypothenar hammer syndrome (HHS) is an uncommon condition that is associated with occupational repetitive injury to the hand. The commonly associated occupations include auto mechanics, machinists, miners, and butchers or occupations requiring the worker to use the hypothenar portion of the hand as a tool. Until now, there has never been a case report of HHS secondary to firearm use. In this report, we highlight a unique presentation of firearm-related HHS.
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Affiliation(s)
- Adrian T Fung
- Division of Vascular Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Jennifer Culig
- Division of Vascular Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - David C Taylor
- Division of Vascular Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Ken J, Khangura D, Stickles SP. Point-of-care Ultrasound to Identify Distal Ulnar Artery Thrombosis: Case of Hypothenar Hammer Syndrome. West J Emerg Med 2015; 16:565-7. [PMID: 26265969 PMCID: PMC4530915 DOI: 10.5811/westjem.2015.4.25888] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 04/28/2015] [Accepted: 04/28/2015] [Indexed: 11/29/2022] Open
Abstract
Hypothenar hammer syndrome (HHS) is a rare condition of distal ulnar artery injury and thrombosis secondary to repetitive blunt trauma to the hypothenar area. We present a case of HHS for which point-of-care ultrasound (POCUS) was used as the initial means of imaging, prompting management and disposition without further imaging studies ordered in the emergency department (ED). This case demonstrates the utility of POCUS to aid the Emergency Physician in the diagnosis and management of patients with extremity vascular issues in the ED, and details a rarely seen clinical entity in the ED.
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Affiliation(s)
- Jonathan Ken
- University of Missouri, Department of Emergency Medicine, Columbia, Missouri
| | - Darshan Khangura
- University of Missouri, Department of Internal Medicine, Columbia, Missouri
| | - Sean P Stickles
- University of Missouri, Department of Emergency Medicine, Columbia, Missouri
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